2020: Finding a Clear Vision for American Health Care

As a new decade dawns, AMCP is preparing for the twists and turns of an uncertain first year. With health care a top issue in this year’s presidential campaigns, drug pricing a favorite target, and biosimilar use poised to expand, seeing where this year will lead requires much more than “2020” vision.

Drug pricing is complicated. Nearly all adult Americans have had the anxious experience of going to the pharmacy and wondering whether they will be able to afford a prescribed medication. The pharmacy has long been one of the few places in the retail environment where prices are unpredictable for even the savviest consumer. Drug coverage has reduced this anxiety, yet for many, medications remain financially out of reach.

Such a scenario leads people to look for solutions. What could be simpler, they may think, than clicking on a website or driving across the border to Canada and purchasing what appears to be the same product at a much lower price? Drug reimportation may be an idea that gets cheers at campaign debates and rallies, but those of us in the field know it is neither a practical nor safe solution to making medicines more affordable. The global market for medications is complicated for many good reasons, and AMCP strives every day to explain this complexity to consumers and policymakers. A difficult problem is not easily solved — but solutions do exist.

Biosimilars provide the perfect example of how managed care pharmacy can create value in American health care. Biologics consume an increasing share of our drug budgets and represent a growing percentage of new drug approvals. A competitive biologics marketplace that includes lower-cost biosimilars and interchangeable biologics is essential to making these important therapies more affordable and accessible. This March, the FDA will start to approve biosimilar and interchangeable alternatives to most protein products originally approved as drug products, including every currently marketed insulin. While more work is needed to extend this pathway to chemically synthesized follow-on insulins and other protein products, managed care pharmacy is ready to incorporate newly approved biosimilars into its value proposition for patients, payers, and providers.

The drug cost issue folds into the larger debate over the American health care system, and that is where managed care can make an even larger contribution by generating ideas and leading the discussion. The disconnected system in the United States is the costliest in the world, and when things go right and patients have resources, it provides great care. For many, though, health care is often not accessible and not affordable. Disorganization leads to errors and waste. Financial incentives can lead to overtreatment, while costs close doors for others.

What are the best solutions for our country’s health care system? Our field of managed care was founded on the concept that a comprehensive, unified approach to the delivery and consumption of health care services leads to optimal utilization of resources at an equitable cost. This approach to health care works in organizations of all types, from closed systems with internal staff to open models using value-driven, dispersed provider networks. We continue to believe solutions built on the principles of managed care are ideal for blending the resources and services of America’s private and public health care providers and organizations into coherent systems that work for patients in a diverse country like the United States.

AMCP and managed care may not have all the answers, but we surely can provide informative insights as this debate ensues. A year from now, on January 20, 2021, the steps of the U.S. Capitol will be streaming red, white, and blue for a presidential inauguration. For the person who will lead our nation over those next four years, health care will be high on the priority list. The Affordable Care Act —which contains the statutory language that created the biosimilar pathway — could be in legal jeopardy as challenges to its constitutionality wind their ways through federal courts. As Americans seek solutions to the continuing challenges of our health care systems, it will be up to us, the managed care community, to be there, ready to advocate on behalf of ideas that create value and efficiency. AMCP is moving with authority into 2020 and promises to be a prominent voice as we develop clearer visions for America’s health care future.